Grooved Pegboard Research Articles

Comparative cognitive effects of carbamazepine and phenytoin in healthy adults

We investigated neuropsychological effects of carbamazepine and phenytoin in 21 healthy adults using a randomized, double-blind, double-crossover design and treating each subject with each drug for 1 month, separated by a 1-month washout. There were neuropsychological evaluations at baseline, the end of each treatment month, and 1 month after the last treatment phase. Cognitive measures included Symbol Digit Modalities Test, Selective Reminding Test, Complex Figures, Paced Auditory Serial Addition Test, Stroop, Finger Tapping, Grooved Pegboard, Choice Reaction Time, P3 Event-Related Potential, Hopkins Symptom Checklist, and Profile of Mood States (POMS). Compared with nondrug conditions, the anticonvulsants significantly impaired Stroop, Choice Reaction Time, Grooved Pegboard, Hopkins, and POMS. Employing anticonvulsant blood levels as covariates, there were only two significant differences between drugs, one in favor of carbamazepine (ie, Finger Tapping) and one in favor of phenytoin (ie, Stroop). The results suggest that differences in cognitive effects of carbamazepine and phenytoin are not clinically significant.

Chronic neurobehavioural effects of toluene.

Neurobehavioural tests were undertaken by 30 female workers exposed to toluene and matched controls with low occupational exposure to toluene. The environmental air levels (TWA) of toluene was 88 ppm for the exposed workers and 13 ppm for the controls. The toluene in blood concentrations for the exposed workers was 1.25 mg/l and for the controls 0.16 mg/l. Statistically significant differences between workers exposed to toluene and controls in neurobehavioural tests measuring manual dexterity (grooved peg board), visual scanning (trail making, visual reproduction, Benton visual retention, and digit symbol), and verbal memory (digit span) were observed. Further, the performance at each of these tests was related to time weighted average exposure concentrations of air toluene. The workers exposed to toluene had no clinical symptoms or signs. The question arises as to whether these impairments in neurobehavioural tests are reversible or whether they could be a forerunner of more severe damage.

Comparative cognitive effects of anticonvulsants

We investigated the neuropsychological effects of carbamazepine, phenobarbital, and phenytoin in 15 partial complex epilepsy patients treated with each drug for 3 months, using a randomized double-blind, triple crossover design. Neuropsychological evaluation at the end of each treatment period included Digit Span, Selective Reminding Test, Digit Symbol, Finger Tapping, Grooved Pegboard, Choice Reaction Time, P3 evoked potential, and Profile of Mood States. Employing anticonvulsant blood levels and seizure frequencies as covariates, the only significant difference was for Digit Symbol. Performance with phenobarbital was significantly worse than with the other 2 anticonvulsants despite phenobarbital's having had the lowest overall blood levels. Our data show that patients receiving carbamazepine, phenobarbital, and phenytoin have comparable neuropsychological performance on most measures. The results suggest that the differential cognitive effects of anticonvulsants may be subtle.

Comparison of preferred and nonpreferred hand performance on four neuropsychological motor tasks

Abstract This study explored the intermanual difference scores in 426 normal subjects on four neuropsychological tests, taking into consideration the effects of age, education, sex, and lateral preference. For the Finger Tapping Test and Hand Dynamometer measures, subjects who consistently demonstrated right lateral preference had greater intermanual differences than did left-handed subjects, while analyses on the Grooved Pegboard revealed that females tended to have larger percent difference scores than did males. Analyses on the fourth measure, the Tactual Performance Test (TPT), did not reveal differences related to lateral preference or sex. However, older and less well educated subjects tended not to improve from Trial 1 to Trial 2 of the TPT, possibly due to less efficient learning. These results suggest that interpretation of intermanual differences in neuropsychological assessment would benefit from consideration of demographic and lateral preference variables, in combinations that differ for specific tests.

Cerebellar Stimulation for Spastic Cerebral Palsy; Preliminary Report; On‐going Double Blind Study

To date, June 1, 1986, 33 spastic cerebral palsy (CP) patients have taken part in a double blind study testing the safety and efficacy of chronic cerebellar stimulation (CCS) for reduction of spasticity and improvement in function. Seven U.S. surgical centers involving ten neurosurgeons have implanted the Neurolith 601 cerebellar stimulator supplied by Pacesetter Systems Inc. (Sylmar, CA). A pilot study was run with three patients at Stanford University (Stanford, CA) using taped-on real (strong) and dummy (weak) magnets to control the ON-OFF status. Following the pilot study, a magnetically controllable switch was placed in line between the Neurolith stimulator and the cerebellar lead to allow more reliable switching sequences for the study. The test battery included joint angle measurements (passive and active), motor performance testing, reaction time, hand dynamometry, grooved peg board placement, hand/foot tapping, and rotary pursuit testing. Testing only was done at presurgery. Testing and ON-OFF switching was performed following recovery from surgery and at one, two, and four months. After four months, the switch was left turned ON. Of the 30 patients using the implanted switch, 11 were dropped from the study and seven are still in progress. Of the 11 dropped from the study, four were due to switch problems and three were due to double blind protocol violations, i.e., the participants discovered the stimulus status. The remaining four were removed because of a broken lead, infection, or unrelated medical problems, or refusal to participate after implant. A preliminary analysis indicated that three-quarters of the patients have a demonstrable quantitative improvement during the time the stimulation was "ON." Three patients showed no significant change.

Low level lead exposure and neuropsychological functioning in blue collar males.

To examine the interrelationships between normal aging, occupational lead exposure, and cognitive functioning, a comprehensive battery of neuropsychological tests was administered to 288 randomly-selected lead-exposed workers and 181 demographically-similar nonexposed controls. Contrary to previous reports, those workers with current blood-lead levels in the low to moderate range (less than 50 micrograms/dl) were found to perform as well as controls on measures of learning, memory, attention, visuospatial ability, and general intelligence. They differed from controls only on one measure of psychomotor speed and manual dexterity, the Grooved Pegboard Test, and these between-group differences were restricted to the older lead workers. It is likely that these results are secondary to lead-mediated neuromuscular damage. There is little support for the view that older adults with current blood lead levels in the low to moderate range are at risk for developing significant CNS dysfunction, even though they may have had a past history of excessively high blood lead levels.

School readiness and intraventricular hemorrhage in children born prematurely

Our objective was to determine scores on tests of neurocognitive functioning in children diagnosed with diabetes before age 10 years and to determine the association of age of diagnosis, duration of diabetes, subtle hypoglycemia, severe hypoglycemia, and history of hypoglycemic seizures with these neurocognitive test scores. Fifty-five of 62 eligible patients with a mean age of 7.9 ± 1.6 years followed in our center were given the Woodcock-Johnson Psychoeducational Battery, Beery Developmental Test of Visual-Motor Integration, Finger Tapping, Grooved Pegboard, and Verbal Selective Reminding tests to evaluate the following domains: memory/attention, visual–perceptual, broad cognitive function, academic achievement, and fine motor speed/coordination. Fifteen age-matched siblings served as controls. Twenty-seven subjects were less than 5 years of age when diagnosed with diabetes, the mean age at diagnosis was 4.5 ± 2.1 years of age, and mean diabetes duration was 2.6 ± 2.0 years. Eighteen patients had a history of severe hypoglycemia, eight of whom had hypoglycemic seizures. The mean HbA1c was 7.8 ± 1.1% for the year prior to testing. Our results showed that the overall mean scores for the extensive neurocognitive battery were within the normal range and were comparable to the scores of the age-matched sibling controls. Age of diagnosis and duration of diabetes did not relate to neurocognitive test results. Mean HbA1c had a negative association with some tests of memory/attention (p < 0.03–0.04) and academic achievement (p < 0.005–0.03), while number of blood glucose levels less than mg/dL had a positive association with memory/attention (p < 0.004–0.04), verbal comprehension (p < 0.03) and academic achievement (p < 0.018–0.05). There was no association of neurocognitive test scores with severe hypoglycemia, but subjects with history of hypoglycemic seizures had a decrease in scores on tests assessing memory skills (p < 0.03) including short term memory and memory for words. These data suggest that overall neurocognitive test scores were within the normal range and comparable to controls. However, specific aspects of neurocognitive functioning may be adversely affected by having had a hypoglycemic seizure, but not by episodes of severe hypoglycemia without seizure. Lower HbA1c and an increase in the number of blood glucose levels less than 70 mg/dL (subtle hypoglycemia) which were associated with higher scores in some domains of academic achievement and memory suggests that stable glycemia may influence cognitive abilities and/or that successful diabetes management requires cognitive skills. Strategies to diminish the risk of seizures with hypoglycemia should be investigated.

Normative data on selected neuropsychological measures from a nonclinical sample

Normative neuropsychological data are provided from a sample of 365, recruited from a nonclinical population. The sample was divided evenly between males and females, although males were somewhat overly represented in the youngest group, and females were somewhat overly represented in the oldest group. The measures included the Trail Making Test, Seashore Rhythm Test, Finger Tapping, Grooved Pegboard, and Dynamometer. The limited number of measures was a result of the time available to study each subject. Normative data were stratified by sex, age, and educational level. The present data were discussed in relationship to previous normative studies and also in the context of the need for additional normative studies.